The intervention features videos of various dental
procedures, such as cleaning, getting a filling and undergoing a
root canal.

“We’re basically giving patients information, sharing withthem what things are for, why the dentist is doing things andwhy it’s necessary to do x rather than y,” says Heimberg. “But themain components are exposure and cognitive restructuring.”For each procedure, there are three videos. Users first watcha dentist perform the procedure, with animated depictions ofwhat’s going on inside the mouth. The next video offers close-upsof the patient’s face but with the dentist talking as a cognitive-behavioral therapist would and helping the patient translatewhat Heimberg calls “Oh, my God!” thoughts into more positivethoughts. The final video lets users experience the procedure asif they’re sitting in the dental chair themselves. “In the voiceover,the patient from the previous video is talking to the patient sittingin front of the computer and helping that patient develop copingthoughts about the procedure,” says Heimberg.

In a randomized, controlled trial of
151 adult patients described in a clinical
research supplement to the Journal of
Dental Research in 2015, Heimberg and
colleagues found that the hourlong
intervention significantly reduced dental
anxiety, fear, avoidance and severity
of dental phobia among patients with
high dental anxiety. (The control group
was assigned to a waiting list.) The
effects were lasting, too: A month later,
fewer patients with full-fledged dental
phobia still met the criteria for phobia.
The researchers now have a grant from
the National Institute of Dental and
Craniofacial Research to conduct a trial of an online version.

Stopping jaw pain

Psychologists are also helping dentists and their patients
address chronic pain, most commonly temporomandibular
joint disorders, which are characterized by pain in the jaw
and the muscles surrounding it and in some cases difficulty
moving the jaw. According to the National Institute of Dental
and Craniofacial Research, more than 10 million Americans —
more often women than men — may have temporomandibular
joint and muscle disorders.

In the past, dentists have attempted to treat the disorder by
replacing a joint or changing the way the teeth fit together. That
approach has been “woefully unsuccessful,” says psychologist
Roger B. Fillingim, PhD, a professor at the University of
Florida’s College of Dentistry. Now, he says, there’s a growing
understanding that complex interactions among physical,
psychological, environmental and other factors contribute to
jaw pain.

To identify those factors, Fillingim and other researcherslaunched the Orofacial Pain: Prospective Evaluation and RiskAssessment study in 2006. Still ongoing, the study collectedinformation about ethnically and racially diverse people withouttemporomandibular joint disorder recruited at the four studysites, then waited to see who would develop the problem.

In a 2013 paper in the Journal of Pain, Fillingim and
colleagues examined psychological variables among more
than 2,700 participants, about 200 of whom had developed
temporomandibular joint disorder. While current and past
stress and negative affect were correlated with the disorder, the
most important predictor turned out to be somatic symptoms
— dizziness, stomach upset, headaches and the like.

That doesn’t mean patients are converting psychological
pain into physical symptoms, a stance Fillingim describes as
unhelpful and pejorative. Instead, he says, people who report
high levels of physical symptoms may just be more attuned to
what’s going on in their bodies than most people.

“Many of us are just tuned differently in our central nervoussystem,” says Fillingim, who also directs the university’s PainResearch and Intervention Center of Excellence. “If your centralnervous system is particularly expert at detecting physicalsymptoms, at one time in the history of our species, that wasincredibly adaptive and kept us from harm; it’s not so adaptiveanymore.”While psychological factors may not be at the root oftemporomandibular joint disorder, psychological interventionscould help, says Fillingim. Cognitive-behavioral therapy,cognitive reframing and affective regulation could changethe way the central nervous system responds to stimuli, hesays. Now he and his fellow researchers are trying to put theirfindings on risk factors to use in developing prevention andtreatment strategies and identifying the patients at greatest risk.

Training dentists

Psychologists also have an important role to play in training
dentists, says Dolores Cannella. Many dental schools now have
at least one psychologist on staff, says Cannella. “It is the norm,”
she says.